AskDrRob (ADR): LOL, EHR, Oprah

It's been a very long time since I did an Ask Dr. Rob post. It's also been a long time since I shot a spitball out of a straw and hit someone behind the ear during social studies class. I realize that just because it's been a long time since I've done something, it doesn't mean the world is better off with me doing it again.

Still, there have been some interesting questions that have come up and I think it's time they should be answered. They are both along the same line:

Question 1: What is the difference between health care and healthcare? I see that you contribute to the Health Care Blog, but you write about healthcare all of the time. What's the deal?

Question 2: What is the difference between EMR and EHR? It seems that some people feel that it is vile and uncouth to call it "EMR", only accepting people who call it "EHR" into their secret societies of people who are smarter than everyone else. What's the deal?

To Space or notto Space

These two questions focus on a very important issue in our society: the place of grammatical elitism in modern society. You see, the folks who write "health care" are very suspicious of those who write "healthcare," as they feel that they wantonly leave out spaces betweenwords and endanger the very fabric of the spacetime continuum by doingso. The "healthcare" camp, on the other hand, thinks that the "health care" crew is just dealing with pent-up frustration from being pottytrained (potty trained) too late and becoming the laughingstock (laughing stock) of the daycare (day care) center.

Back and forth the sides go, the one saying that the misuse of spaces between (be tween) words will open up a wormhole (worm hole) in the Internet (inter net) causing Twitter messages to be reduced to 30 characters (soyouwouldhavetoleaveoutspaces), and for every common expression to be reduced to abbreviations like LOL, ROFL, and ROTC. Doing so would kill all human life, leaving only cats to LOL away their days in blissful laughter. But there would be nobody there to laugh.

This makes them very FATFOH (fearful about the fate of humanity).

The "healthcare" crew takes exception to this portrayal of their space usage as being the same malignant disease that created BFF's, the CIA, and LSD. They cite the frequent shortening of words in the medical field as their precedent for the omission of the space, such as PMR (polymyalgia rheumatica), "A Fib" for atrial fibrillation, and the original LOL (Little Old Lady). They also argue the importance of conservation in these days of global warming (GW), oil spills (BP), and Dancing With the Stars (DWTS). All of these are portents of darker days ahead, and so we should be conserving all of the space on the Internet possible to deal with these terrible threats. Clearly the medical field needs to lead the battle against this, not a bunch of cats getting sucked into vacuum cleaners.

Who is right in this battle? I have put myself into the "healthcare" camp, but with reservations. I do wonder about worm holes eating up the inter net. I do fear the final domination of the world by cats getting sucked into vacuum cleaners and the disappearance of my BFF's. But being proactive I comedown on the sideof the ones who wantto take action. I don't think weshould just sitthere and donithing except argue about the useofspaces.

ThatswhereIstand.

Evolution of Electronic Records

So what about the whole EMR/EHR debate?

You can see that these folks are in the "healthcare" camp, with the use of the abbreviation. But within the camp of those who would shorten things there has formed a rift that may bring down any constructive work the leavingout of spaces accomplishes. Unlike the "health care" vs "healthcare" debate, the fighting hasn't spilled out to violence on the streets, but it has caused some nominees for CMS to get OTD PDQ before they ended up MIA.

As many of you know, the term "EMR" stands for "Electronic Medical Record," while "EHR" stands for "Electronic Health Record." The difference is not in the E or the R, it is in what lies between.

The original computerized records were called "CPR," which stands for "Computerized Patient Record." This was all fine and good, and there was little dissent among the three doctors who used it at that time. But an astute medical student noted that CPR also stands for "Cardiopulmonary Resuscitation," as well as for "Colorado Public Radio." The confusion over these abbreviation caused dying patients to have "All Things Considered" given STAT, caused Ira Glass to be stalked by people wearing scrubs, and caused doctors to pause for 30 minutes of every hour to beg patients for money.

So with the urging of the patients not wanting to buy a copy of the musical "CATS" for $50, the families of resuscitated patients lamenting the now liberal bent of their saved loved-ones, and Ira Glass doing a "This American Life" episode on the fact that he was alive and his heart was beating just fine, the convention of "EMR" was adopted.

All things were quiet in the world of EMR, and, despite the fact that EMR also stands for "Emotionally Mentally Retarded," "Electromagnetic Radiation," and "Enormously Magnificent Radishes," the adoption rate skyrocketed to a whopping 20 doctors.

The Power of Oprah

But this all changed with the advent of the PC movement, which originated in the bastion of evil liberals, Madison, Wisconsin. By "PC," I am not referring to the "Personal Computer," which originated in the bastion of blue screens of death, Redmond, Washington. I am also not referring to "Processed Cheese," which was an attempt by the AARP to slow down "all of those young whipper-snappers" by making all children severely constipated.

I am referring to the "Politically Correct" movement that exists with a single purpose in mind: to make us feel guilty for calling anyone by their race, sex, physical defect, or occupation. They made it impossible to classify people at all, instead preferring that everyone be called sexually non-specific names, such as "Pat," "Jean," "Taylor," and "Hillary." The inevitable infiltration by this movement into the medical field occurred after the failure of the Clinton Health Reform bill (hardly a coincidence). Their damage includes:

The use of the word "provider" instead of "doctor."

The use of the word "inadequacy" instead of "disease."

The use of the phrase "conspiracy to poison us all" instead of the word "medication."

The use of the phrase, "the one who really runs the show" instead of the word "nurse."

They also felt that the word "medicine" might cause people to believe that the pharmaceutical industry actually did something good, rather than their known practice of stealing money out of our pockets while they poison us. They convened a summit, which included such luminaries as Oprah Winfrey, Donald Trump, and Sanjay Gupta, ending with the substitution of the word "medicine" with the word "health." Oprah suggested that use of the word "health" would result in people having a more positive attitude and perhaps encourage them to get a makeover (make over). Trump and Gupta were just bent on world domination (unlike Oprah, who is just so darn nice).

Feeling the pressure, the Health Information Management Systems Society (HIMSS) suggested changing the abbreviation of EMR to EHR. They did this because their abbreviation clearly was shaky from a PC standpoint. They had already changed their letterhead (letter head) from MIMSS to HIMSS, and didn't want to cave to the pressure from Oprah once more. So now the battle rages among those who feel it's OK for the pharmaceutical industry to poison us all while taking our money, and those who think we should listen to Dr. Oz and take better gosh-darn care of ourselves.

Where do I stand on this issue? I was trained to call it EMR, but feel guilty at times and call it EHR. The problem is that when I type EHR on any Microsoft product, it changes it automatically to HER, which makes me wonder if Oprah has more influence than I ever knew.

Final Questions

Before closing, there are a couple of questions I want answered:

Why do Emergency Physicians insist on calling their workplace (work place) an ED, instead of an ER. Is this pressure from the pharmaceutical industry to increase the use of Viagra in an emergency setting?

Why is PMS being changed to PMDD? Clearly there is an additional letter in that abbreviation, so it is not in the wordshortening camp. Is it because PMS can be confused with the phrase "Pass My Shotgun?"